you may be right,but i was assured that is not the case,it is purely a medical decision,maybe its different in other countries,and may be based on money?
The ONLY guidelines that mention cost effectiveness at all are the 2008 UK NICE guidelines and and that is why their recomendations are different than the other Orgs and Countries
the one thing that the 2008 NICE guidelines say they take into effect that all the other orgs don't is COST. it is very long, 107 pages but
(bottom of page 11-12 )
http://www.nice.org.uk/nicemedia/pdf...CEguidance.pdf
"Four clinical guidelines on the prevention of IE are discussed in subsequent sections: American Heart Association (AHA) 2007 (Wilson et al. 2007), British Society for Antimicrobial Chemotherapy (BSAC)
2006 (Gould et al. 2006), European Society of Cardiology (ESC) 2004 (Horstkotte et al. 2004) and British Cardiac Society (BCS)/Royal College of Physicians (RCP) 2004 (Advisory Group of the British Cardiac Society Clinical Practice Committee 2004).
The recommendations of these four guidelines, and where reported the rationale for their recommendations, have been considered by the GDG in the development of this guideline. However, it should be emphasised that the GDG has based its recommendations on an independent consideration of the available clinical and cost-effectiveness evidence and, where appropriate, expert opinion."
right before that on page 10 it says
Infective endocarditis (IE) is an inflammation of the endocardium, particularly affecting the heart valves, caused mainly by bacteria but occasionally by other infectious agents. It is a rare condition, with an annual incidence of fewer than 10 per 100,000 cases in the normal population. Despite advances in diagnosis and treatment, IE remains a life-threatening disease with significant mortality (approximately 20%) and morbidity.
The predisposing factors for the development of IE have changed in the past 50 years, mainly with the decreasing incidence of rheumatic heart disease and the increasing impact of prosthetic heart valves, nosocomial infection and intravenous drug misuse. However, the potentially serious impact of IE on the individual has not changed (Prendergast 2006).
Published medical literature contains many case reports of IE being preceded by an interventional procedure, most frequently dentistry. IE can be caused by several different organisms, many of which could be transferred into the blood during an interventional procedure. Streptococci, Staphylococcus aureus and enterococci are important causative organisms.
It is accepted that many cases of IE are not caused by interventional procedures (Brincat et al. 2006), but with such a serious condition it is reasonable to consider that any cases of IE that can be prevented should be prevented. Consequently, since 1955, antibiotic prophylaxis that aims to prevent endocarditis has been used in at-risk patients. However, the evidence base for the use of antibiotic prophylaxis has relied heavily on extrapolation from animal models of the disease (Pallasch 2003) and the applicability of these models to people has been questioned. With a rare but serious condition such as IE it is difficult to plan and execute research using experimental study designs. Consequently, the evidence available in this area is limited, being drawn chiefly from observational (case–control) studies
. I wasn't quite angry enough to embarass her over it but I was glad I'd taken my antibiotics (and I won't let her near my teeth the next time I go in).
